We are not now that strength which in old days...

I had Covid the last few weeks of March 2020, right at the beginning of the pandemic (early adopter, cannot recommend, 1 out of 5 stars.) Medically my case was classified as “moderate,” because my SpO2 dropped below 90%, but I wasn’t hospitalized and didn’t require supplemental oxygen. After my fever finally broke for good, so that I was officially “over” Covid, I had several Covid symptoms that took many months to go away, while others have never gone away, and have even worsened with time. By the end of summer 2020, I had read several reports of people who were experiencing similar things, often with more severe symptoms than I was having, so I actually felt lucky that I wasn’t as bad as some people were. Although I was getting frustrated with the slow pace of my recovery, I still had an expectation that given enough time and work on my part, I would eventually get back to “normal" (i.e. how I was before I had Covid.)

Then, in September 2020, my family experienced a major trauma—one that we are still working through today. I fell into a deep depression. I struggled to complete tasks at work, didn’t cook a meal for six months (we ordered out every night), and cried every day—often multiple times a day—for nine months. It actually seems ridiculous to me now, but I was several months into the experience before I even started wondering if I was depressed in the clinical sense. By June 2021 I was so bad that I told my wife Janel that I wasn’t sure I could hold a full-time job any more, and even doubted that I could successfully work part time.

Janel helped me find a therapist and a primary care physician (I didn’t have a doctor at the time), and I started regular therapy and medication to treat my depression. At that point, I attributed all the problems I was having (difficulty concentrating, reduced memory function, constant fatigue) as being due to my depression only, so expected that as my depression got better that those symptoms would also get better.

At first, my expectations seemed to be met; as Janel, my therapist, and the medication slowly helped me work my way out of the depths of my depression, I also started to slowly see improvement in my symptoms. Although I knew I had a long way to go, I felt like I was going in the right direction.

I work at the Colorado Space Grant Consortium at CU-Boulder, where we work with students who participate in NASA and space industry funded projects. We work with students year round, but much of our workload follows the academic year, which means for me that summers are a bit more relaxed, and times during the fall and spring semester tend to be busier and more hectic. During the fall 2021 semester, as my work load ramped up, I could feel my cognitive problems worsening again. By the beginning of October, I was struggling as much as I had been in June. One day at the end of October I got up and wasn’t sure I could actually go in to work that day, because I felt like I might no be able to concentrate enough to do the things I needed to do to leave the house, like tie my shoes or pack myself a lunch.

By using all of my focus, I was able to go into work. When I got to there, my boss asked me to do something in addition to what I had on my schedule for that day, and after thinking about it for a while, I had to tell him that I couldn’t. I knew that I didn’t have the necessary concentration to do anything but the absolute “must dos” on my to-do list for the day—things that if I was functioning normally would have taken me about an hour to complete. After talking more with my boss about the condition I was in, we decided what I needed to do was take some time off so I could concentrate on getting better, so I went on FMLA leave from the end of October to the first of February.

During December, I was listening to an interview with a British physician who had long Covid around the same time I did, and seemed to have symptoms—in particular cognitive symptoms—similar to mine. She mentioned an online cognitive skills test that researchers were using as part of different studies of how different illnesses affected people's cognition (The Great British Intelligence Test.) Curious about how the more objective measures from the test would compare to my subjective impressions of how my mind was working, I took the test.

I did even worse than I expected. The test is scored by giving you how well you did compared to people of the same age as you. For example, if you scored a 60% on a particular test, you did better that 59% of the people your age who had taken that same test. My best scores were on simple arithmetic skills, around 80%. That’s not bad, but all my college degrees—including my PhD—are in highly quantitative areas (math and physics.) And, when I taught physics classes, I was famous (perhaps notorious) for working out the numerical answers to example problems in my head, usually more quickly than students could using their calculators.

My scores for most tests of memory were in the 30-50% range; not horrible, but given that I have spent my entire career working on complicated tasks that require holding and retrieving a lot of information from memory, lower than I expected (in the past Janel would often say that I had a “trivial mind,” because of my ability to recall obscure facts about many different subjects.) Worst of all, my score for sustained attention was 1%—essentially, almost no-one my age who had taken the test performed worse than I did.

In January, I received a request from The Intelligence test to take it again, as part of new study a research group was conducting. When I repeated the test, a few of the tests were the same as I had taken before, covering most but not all of the same cognitive skills as the previous test. On tests that covered skills I had been tested on before (e.g. short-term memory or arithmetic), my scores were very similar to those from the previous test. This time the test did not include a test of sustained attention, but did have a test of working memory, on which I scored 1%.

To say that these test results scared (terrified?) me would be a gross understatement.

From the beginning of November to early January, I kept working with my therapist, and my PCP and I worked together to adjust my medications. At that point we were all still working under the assumption that my depression—which had definitely gotten worse again—was to blame, so that if we could get that under control, that the symptoms would largely go away. Over the next couple of months, my depression improved significantly, but the improvement in my cognitive skills was much more modest. Eventually, by the beginning of January, my therapist and I had independently concluded—from multiple lines of evidence include my Intelligence Test scores— that the root cause of the cognitive problems was long Covid, and not my depression.

I also should mention--with some chagrin--that Janel had been telling me since my “recovery” that I wasn’t the same as I had been before contracting Covid; not just physically but cognitively as well. When I finally said to her “I think these problems are largely due to long Covid and not my depression” her response was “Well duh, I’ve been telling you that for a year and a half now!”

So, with my depression under control, Janel, my therapist, my friends, my co-workers and I have started working on how I can manage my long Covid with the expectation that I probably won’t be able to return to how I was. Instead our goal is to figure out what I can actually manage to do and sustain over the long term.

I returned to work on February 1, 2022. For my first three months back at work (at least), I am working a 20 hour/week schedule, with the goal of determining whether I can even manage working that much—so far it’s still not clear whether I can or not.

I have been able to get an initial appointment at Jewish Health’s Center for post-Covid Care and Recovery on March 22, so I’m at least hopeful that over the next few months I’ll be able to get evaluated and treated by specialists that cover the range of long Covid symptoms I have. However, at this point my expectation is that there will be no quick (or slow) fixes. While a lot of research is being done, and although there are a number of promising leads, the medical community has not yet been able to determine the root cause of long Covid. Until they do, the best that can be done is to treat long Covid as a chronic disease that might be managed, but not cured.